The URL can be used to link to this page

Home My WebLink AboutBLD2012-00312 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 Carl Smith, Director/Building Official PERMIT#: BLD12-00312 SITE ADDRESS: 31 ANDERSON ST Issue Date: 11/6/2012 PORT HADLOCK, 98339 Final Date: 4/16/2013 APPLICANT: DANIEL H SHAW PHONE: 360-732-7018 SHERI J SHAW PO BOX 515 CHIMACUM WA 98325-0515 SUBDIVISION: IRONDALE#7 Block: 87 Lot: 39-43 PARCEL NUMBER: 961808705 Section: 34 Township: 30 N Range: 01 W PROJECT DESCRIPTION: M/H THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 4/16/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 5/22/2013 1 • • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD12-00312 Received Date: 10/4/2012 SITE ADDRESS: 31 ANDERSON ST Issue Date: 11/6/2012 PORT HADLOCK, 98339 APPLICANT: DANIEL H SHAW SHERI J SHAW PO BOX 515 CHIMACUM WA 98325-0515 SUBDIVISION: IRONDALE#7 Block: 87 Lot: 39-43 PARCEL#: 961808705 Section: 34 Township: 30 N Range: 01 W CONTRACTOR/ MABRY CONSTRUCTION PHONE: 360-876-0509 DEALER PO BOX 558 PORT ORCHARD WA 98366 Contractor's License MABRYC*923B5 Expires 1/3/2014 PROJECT DESCRIPTION: M/H MAKE: GOLDENWEST YEAR: 1997 SIZE: 44X27 Directions To Site: To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. Office Hours 9:00 -4:30 MONDAY-THURSDAY ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks + Erosion Control MH Foundation Blocking&Tie Down 'lt—lit—k Skirting&Ventilation Gas Line: Exterior Propane Tank Pressure Test Drywell/Alt Drainage Address Posted FINAL INSPECTION ul /q/, FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR SPECIAL CONDITIONS APPLY-SEE REVERSE GILDING PERMIT APPLICA1 Review N 00217 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00312 Received Date: 10/4/2012 SITE ADDRESS: 81 ANDERSON ST OWNER: DANIEL H SHAW PHONE: 360-732-7018 SHERI J SHAW PO BOX 515 CHIMACUM WA 98325-0515 IRONDALE#7 SUBDIVISION: Block: 87 Lot: 39-43 PARCEL NUMBER: 961808705 Section: 34 Township: 30 N Range: 01 W CONTRACTOR: MABRY CONSTRUCTION PHONE: 360-876-0509 PO BOX 558 PORT ORCHARD WA 98366 Contractor's License MABRYC*923B5 Expires 1/3/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION M/H TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: 1,188 CODE EDITION: 2009 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: 05783 BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 23 Total: 2 Routing Date: - I0 4—(2_ -- Type Amount Paid By: Date: Receipt: Approved/Date Permit $0.00 LYK 10/04/12 Potable Water Application $64.00 LYK 10/04/12 135275 APPROV D Total: $64.00 NOV (0 2w2 . 3ifar Ca''ia;y PIaaa;rg & Building Department \\f4rlcmor4\rIn+n\fnrmc\C RI 1'1 Ann Rid ref -I rl/A/7r117 • • SPECIAL CONDITIONS CASE # BLD12-00312 1.) 2012 DOE STORMWATER MANUAL DRYWELL DESIGN CRITERIA ALL INFILTRATION SYSTEMS SHOULD BE AT LEAST 10 FEET FROM ANY STRUCTURE, PROPERTY LINE, OR SENSITIVE AREA. FOR SITE WITH SEPTIC SYSTEMS, INFILTRATION SYSTEMS MUST BE DOWNGRADIENT OF THE DRAINFIELD UNLESS THE SITE TOPOGRAPHY CLEARLY PROHIBITS SUBSURFACE FLOWS FROM INTERSECTING THE DRAINFIELD. DRYWELL BOTTOMS MUST BEA MINIMUM OF 1 FOOT ABOVE SEASONAL HIGH GROUNDWATER LEVEL OR IMPERMEABLE SOIL LAYERS. EACH DRYWELL MAY SERVE UP TO 1000 SQUARE FEET OF IMPERVIOUS SURFACE FOR EITHER MEDIUM SANDS OR COURSE SANDS. TYPICALLY DRYWELLS ARE 48 INCHES IN DIAMETER (MINIMUM) AND HAVE A DEPTH OF 5 FEET (4 FEET OF GRAVEL AND 1 FOOT OF SUITABLE COVER MATERIAL). FILTER FABRIC (GEOTEXTILE) MUST BE PLACED ON TOP OF THE DRAIN ROCK AND ON TRENCH OR DRYWELL SIDES PRIOR TO BACKFILLING. SPACING BETWEEN DRYWELLS MUST BE A MINIMUM OF 4 FEET. 2.) CONSTRUCTION ENTRANCES SHALL BE STABILIZED WHEREVER TRAFFIC WILL BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS OR OTHER PAVED AREAS WITHIN 1,000 FEET OF THE SITE. THE ENTRANCE SHALL BE CONSTRUCTED ON A FIRM COMPACTED SUBGRADE. QUARRY SPALLS (OR HOG FUEL) SHALL BE ADDED IF THE PAD IS NO LONGER IN ACCORDANCE WITH THE SPECIFICATIONS. (BMP C105, 2005 DOE STORMWATER MANUAL). ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY SHOVELING OR STREET SWEEPING. THE SEDIMENT COLLECTED BY SWEEPING SHALL BE REMOVED OR STABILIZED ON STIE. ANY QUARRY SPALLS THAT ARE LOOSENED FROM THE PAD, WHICH END UP ON THE ROADWAY SHALL BE REMOVED IMMEDIATELY. UPON PROJECT COMPLETION AND SITE STABILIZATION, ALL CONSTRUCTION ACCESSES INTENDED AS PERMANENT ACCESS FOR MAINTENANCE SHALL BE PERMANENTLY STABILIZED. 3.) The application was reviewed by the Jefferson County Department of Community Development staff on November 5, 2012 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: seismic; SARPA aquifer recharge area. 4.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 5.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 6.) Critical Aquifer Recharge AreSre defined as Seawater Intrusion Areas, *Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1)All Industrial Land Uses (2)All Commercial Uses (3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit(5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 7.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 8.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 9.) The applicant is proposing to create or add 1800 square feet of impervious surface and 3900 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require your proposal comply with Minimum Requirement#2 (Construction Stormwater Pollution Prevention) of the Department of Ecology Stormwater Management Manual for Western Washington to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 10.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP) Elements#1 through#12 of the Department of Ecology's Stormwater Management Manual for Western Washington to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 11.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(1)(b)(i). 12.) The site plan as submitted with the manufacture home permit application on October 4, 2012 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated November 6, 2012 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 13.) This approval is for a manufacture home installation only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 14.) The parcel has been designated as interim zoning of RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. Current zoning designation is Low Density Residential (UGA-LDR 4-6). 15.) A Restrictive Covenant for Irondale/Hadlock Sanitary Sewer System No Protest Agreement was recorded on October 22, 2012 under AFN 570883 with the Jefferson County Auditor. 16.) A Declaration of Restrictive Covenant has been recorded on October 22, 2012 under AFN 570884 for the purpose of consolidating the lots to meet minimum land area requirements for on-site septic ad to allow zero lot line setbacks. The Covenant is strictly for building and septic purposes only. 17.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 18.) Not more than 2 unlicensed vehicles shall be stored on any lot unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor vehicles is prohibited except in those districts where specified as an automobile wrecking yard or junk (or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter 18.18 JCC, and such storage shall meet the requirements of JCC 18.20.100, Automobile wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor vehicles be stored in a critical area. 19.) A minimum of two (2) on-site•ing spaces shall be provided for the sing mily residence. 20.) This parcel is within the Chimacum Creek no shooting area per JCC 8.50. 21.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 22.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 23.) Minimum setback from Anderson Street right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 24.) The building height is not to exceed 35 feet. 25.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. Pre-existing legal lots of record less than one acre in size in rural residential districts are subject to the stormwater requirements in Chapter 18.30 JCC and must meet the "Area of Impervious Surface Coverage" to the maximum extent practicable as determined by the administrator. Lot coverage is defined as amount of impervious surface, which includes rooftops, driveways, concrete, etc. 26.) An address of 31 Anderson Street, Port Hadlock has been assigned to the parcel. Anderson Street is a county local access (C663209). 27.) The parcel is served by the Quimper public water system. 28.) The parcel was created under the Irondale#7 Subdivision on October 14, 1910 under AFN 31326. 29.) A septic permit was issued on November 5, 2012. 30.) NOTICE: This permit does nxcuse the proponent from complying wither local, state, and federal ordinances, regulations, or statutes applicable to the proposed development, but consistent with RCW 90.58. Development pursuant to this permit shall be undertaken subject to the applicable policies and performance standards of the Jefferson County Shoreline Management Master Program and the Jefferson County Unified Development Code. If during excavation or development of the site an area of potential archaeological significance is uncovered, all activity in the immediate area shall be halted, and the Administrator shall be notified at once. The Federal Endangered Species Act rules to protect threatened Chinook and Summer-run Chum salmon became effective on January 8, 2001. Bull trout have been listed as threatened since early 2000. Under the ESA, any person may bring lawsuit against any individual or agency that"takes" listed species (defined as causing harm, harassing, or damaging habitat for the listed species). In addition, the National Marine Fisheries Service can levy penalties. All areas in Jefferson County are included as"critical habitat"for a listed species. Development of property along any marine shoreline, freshwater shoreline, or floodplains could harm habitat if protective measures are not taken. To minimize the potential to damage habitat, all property owners developing adjacent to marine shoreline, freshwater shoreline, or floodplains are advised to do the following: -All development activities should avoid unstable slopes, wetlands, and forested areas near surface waters - Remove minimal vegetation for site development, especially large trees -Allow trees that have fallen into surface waters to remain there - Infiltrate stormwater from buildings and driveways onsite through drywells rather than discharging directly into surface waters or roadside ditches The Federal Bald and Golden Eagle Protection Act requires landowners within 660 feet (1/8th of a mile) of an eagle nest to consult with the US Fish and Wildlife Service. This Eagle Act prohibits anyone from "taking" bald eagles. This federal law defines the term "take" and describes the possible legal consequences when a "take"occurs. Among other actions, "take" includes a disturbance of bald eagles or their habitat. Under federal law a permit may still be required for activities that impact bald eagles or their habitat. Contact the US Fish and Wildlife Service (http://www.fws.gov/pacific/eagle/) to learn more about how this law affects your project. Any individual, group, or agency can bring suit for a listed species "taking", even if you are in compliance with Jefferson County development codes. The risk of a lawsuit against you can be reduced by consulting with a professional fisheries habitat biologist, and following the recommendations for site development provided by the biologist. For more information, contact the National Marine Fisheries Service in Seattle, or the U.S. Fish and Wildlife Service. \\tidemark\data\forms\F_BLD_Perm it_Mobi le.rpt 11/6/2012 JACK WESTERMAN III • Jefferson Countl:ourthouse ASSESSOR PO Box 1220, Port Townsend, WA 98368 (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: hank l IJv J J? 51/4kv ADDRESS: f'D 60x 5/ j / Al/4 9a.3Z5 PHONE NO. 3 Co6 - 3 0/ 5-760 0 The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile hone is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. 1)MOBILE HOME DATA: (A) MAKE 601dCn w CS* (B) MODEL I/1 ? (C) YEAR / 1 / 7 (D) LENGTH i711/ (E) WIDTH 2 7 (F) SERIAL # G WO R 23 N/8 79O (G) YOUR PURCHASE PRICE (Do not include sales tax)Ar7�O.DO PURCHASE DATE '/I/Zo/L 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEWMOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE D/ff/I'G t tflpi ADDRESS '7 0 5-C /7 /1, 5 / r'C' 4 7)7 0/4 / e-36 8 (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No If Yes, Previous address of mobile. HO q S$e.5S/n7eni 1 / ice.- O I S intl. 0u4S If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: i � -' (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes o� (B)IF LOCATED IN MOBILE HOME PARK: _NAME & ADDRESS OF PARK J v i Lot/S I c (C) IF NOT LOCATED IN MOBILE HQME PAR A: JEFFERSON COUNTY NAME OF LAND OWNER: /re- DOTE/C'f _ tEPT..OF COMUNITY DEVE10°Mc^7. LOCATION ADDRESS REAL PROPERTY PARCEL #/DESCRIPTION 90/ /YZ v �.� G h i'na"c-'*i f-irz l-fq/l #.7E Signature of applicant THANK YOU FOR YOUR HELP! Lauralce Kiesel, Property Technician • is_SON c06, JEFFERSON 'UNTY ' .A DEPARTMENT OF COMMUNITY DEVELOPMENT '' - ` '4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax �IS, p� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: t ( 7 Project Description(include separate she is as necessary): I1'14nv/4ctvfed /lei- /nsf,i/ -/y1oted Iasi C AongIujn FITC fir/ Tax Parcel Number: (a/803 7Os Property Size: /Zis-00 ,cf (acres/square feet) Site Address and/or Directions to Property: 3 `l ,4iderso 1 — ge/k 416-6rot/cs L-10 fee S/hip L7- % Property Owner(s)of Record: D rl i G✓ J/ Telephone: .3 0 73e- 70/8 Fax: S�/rry e. email: Sji 4 Gil l _ y1L44) Mailing Address: PO ,Rvx 375 Ch;41Uc an-, (A119 9832,<— Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit? (Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),_r(d * Manufactured Home .0 Modular V ❑ Discretionary"D"of ar, i��' F l rijifiWn_t ❑ Commercial* 0 Special Use(Esser�tiall ,ru —17.`i•h Change of Use 0 Boundary Line Adjustmdrjt ❑ Address 0 Road Approach 0 Short Plat** 1 `' ❑Home Business 0 Cottage Industry 0 Binding Site Plan*' ; 1 1 , -- , • ❑ Propane 0 Long Plat** I 0Sign - 0 Planned kurai Reskd'ent a Develo.merit PRRD/A I- •m nts** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** JEUFERSON COUNTY ❑ Stormwater Management 0 Shoreline Master Prograr,RE;xgrrptigp prpli)E ►IStCshs** ❑Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline ManagemenTSubstantia eve opment** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ____Z41/144,Cv ✓ ..J1,1t-- to pl Date: / `2 / - Zv/Z. By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application t he or§She wants pnoo notice. Signature: e.�2 ,e-K_ �/�1•,(-',-__ Date: 9-2 7, ZOO 2 The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are id,compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable s O ibility for adhering to a complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: G'I1 .e 4 / Date: 9-27- 2_C)/ Z • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assure• g the responsibilit��he General Contractor for the proposed project. Signature: C ,e "c-L-- Date: /O/2./Z.G/'2 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: /191 B r pCD 0St/uc-fioil (36e) 8 76 -0505 (3coo) • 81 y `O ,L3 MAILING ADDRESS: Pb DC X S se Port orh4fd to I a o.366 EMAIL: $AQ�/ cQ IMR7(�C zkyv e 6 mail �orri CONTRACTORS LICENSE //t� (� WAINS Y NUMBER: MA D RY C ' 923 B 5 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: E New D Wood Existing: 2 ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System E Alteration/Remodel ❑ Concrete Total: _ Height: 12(Individual Sy§t o Repair ❑ Masonry SEP Permit# t l tt O Demolition ❑ Other: Bedrooms: 3 Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: Z Public Total: Name of System: Q thinpcY' If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed • IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No . If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: I Underground Tank 1 Above ground Tank Size of Propane Tank: I Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines, buildings and septic system components, including the reserve area. Square Footage [ Jrrent Proposed For Office Use Only . Amount • Revision Main Floor Heated EH Bld App Review: n' 2"4 Floor Heated Consistency Review: I ll� Other Heated Base fee: c3� Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated' Pot Water Review fee i Garage/Carport SUBTOTAL l Decks 911/Rd Approach fee: Other TOTAL: $ 3 C -5 Receipt Number: 1 35a Cash/Check Number: ' 07a ESTIMATED COST(REQUIRED) Date: '1 ( ^� •Fair market value of all labor and materials foundation to finish 10 ` 1 Initials: - ----- \ • • , ._______________ .27 DootZ 4 I I3 -4 rzr, I 4 r"-- -7c - ... Q\ tfl aM 1 _ 4-- 7 . re--;-- - 6 ---)i I c7 Cs. Z k.IV f 1 -, . 111) 1----- ----J \\ ,I)r-• z rt) , ct....11. s„ s 0. 1 .;,‘,N 4— /o • .\ 737.5 ••••••••••• tZ;) r' N _.. . ..71, )s....Aro 5- d.... 0 .. -1 3 LA - s:a ....... , -v ., _i C3 " ' ... g .‘--- -A- -- .-...__.,v....\.: 01..11 ;'•D " " - 4 . 1 "4" ty....,. .----*•Vilka 71 I t 11 if --t7 i rrli 1 r--Q) • It\ I I ' .... . 0 Pk/ Vt i g=a, ' 1\ r(-•,\ m - c-- ) 0 tv CI) •,n .7 :) cn . ii 3 1 — --- "---,. q,4. 30(I) ..•\,,1 ----..\ \-N -17,. >•••_., . ri--1 -'',- . 7t) --t. ..1\ .........* 0 ..... , E - E Z --i -- - E ------ RI rrl i ?i, / _/' 0 0 _ m i J-9 1 i--- -I 1 Im i — //////11 --4- i r;- • Lf) N,_. _.u . _ ,,u Z .11i1.0.1.. > , g 1 p.7' . 1) ; N c0 C-' -') cn --k-.. C.,..... r'l•-) '' -0 z I." \.1, rn 1) * c ). r43 ...„.t.,..„..._ „....", 0 ........_ 1. .0 , ,... • :. , 1 ' m ) p-i ..... , f'- ,. z 73 .,... m 0 -`• :1" Q. CA 0.T.1 v IL 'gilt .. I r 1 II I It. Pi CD ,.3 o-ti ..< - ....., 1 — ,.._ 1r 7 --", r*1 .__., -, ,.. -1-1 0 0 a c; co. „, . ffil IN ci c.e_ ,.., — ..> CD "--.D g 4, r rl ?:1 ..s. f, = cp 9 4 i ...., ,-„, ,-,11 atr - ' ) c, . i . , ,,$; ; iThl I Nr, ) ,.. c-) 1 '; '-1 7------ --- 1 1 I N., i '01 1 . li i 3 1 ....__ _j) ir IN